Paediatric Periodontitis

Question 1

What are the 2017 World Workshop classifications of periodontal diseases?

Answer 1

• Periodontal health
• Gingivitis: dental biofilm-induced
• Gingival diseases and conditions: non dental-biofilm induced
• Necrotising periodontal diseases
• Periodontitis
• Periodontitis as a manifestation of systemic disease
• Systemic diseases or conditions affecting the periodontal supporting tissues
• Periodontal abscesses and endodontic-periodontal lesions
• Mucogingival deformities and conditions
• Traumatic occlusal forces
• tooth and prosthesis related factors

Question 2

What pneumonic can be used to remember the classification of periodontal conditions?

Answer 2

please give greg nine percy pigs straight past meal time tonight

Question 3

What is periodontal health?

Answer 3

A state:
- free from inflammatory periodontal disease
- allows individual to function normally
- attached gingiva with stippling
- triangular papilla

Question 4

What are the clinical features of a health periodontium in children?

Answer 4

• gingival margin several millimetres coronal to the CEJ
• gingival sulcus 0.5-3mm deep on a fully erupted tooth

Question 5

Where does the alveolar crest lie in reference to the CEJ in teenagers?

Answer 5

0.4mm-1.9mm apical

Question 6

What would place a patient in the category of periodontal health with reduced periodontium?

Answer 6

Non-perio patient =
- crown lengthening surgery
- recession

Periodontal patient =
- stable periodontitis

Question 7

What are the types of gingival conditions that may be seen in children?

Answer 7

1. Plaque biofilm-induced gingivitis
2. Non dental biofilm-induced gingival conditiond

Question 8

Explain how plaque biofilm-induced gingivitis can result in false pocketing:

Answer 8

• supragingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in gingival connective tissue
• junctional epithelium becomes disrupted
• allows apical migration of plaque and an increase in gingival sulcus depth

Question 9

What are examples of non dental biofilm-induced gingival diseases and conditions?

Answer 9

• genetic
• traumatic lesions
• manifestations of systemic disease
• drug induced
• infective

Question 10

Give examples of genetic causes of non dental biofilm induced gingival disease:

Answer 10

• hereditary fibromatosis (overgrowth of gingival tissue)
• thin gingival biotype

Question 11

Give examples of traumatic causes of non dental biofilm induced gingival disease:

Answer 11

• thermal damage (eg burns)
• physical damage (eg toothbrushing, gingivitis artefacta)

Question 12

Give examples of systemic disease causes of non dental biofilm induced gingival disease:

Answer 12

• haematological conditions (eg lymphoma/leukaemia)
• granulomatous inflammation (crohn’s, sarcoidosis)
• immunological conditions (lichen planus, hypersensitivity reactions)

Question 13

Give examples of drug-induced causes of non dental biofilm induced gingival disease:

Answer 13

• lichenoid drug reactions
• cytotoxic drugs (methotrexate, hydroxychloroquine)
• calcium channel blockers (nifedipine)
• anticonvulsants (phenytoin)
• immunosuppresants (cyclosporine)

Question 14

What are the risk factor aetiological aspects of necrotising gingivitis?

Answer 14

• socioeconomic factors (developing countries or poverty)
• smoking
• immunosuppression
• stress
• malcourishment
• poor diet

Question 15

What are the local factor aetiological aspects of necrotising gingivitis?

Answer 15

• root proximity
• tooth malposition

Question 16

What are the systemic aetiological aspects of necrotising gingivitis?

Answer 16

HIV positive status

Question 17

What are tooth anatomical plaque retentive factors that you may see?

Answer 17

• talon cusp
• cingulum
• enamel pearl
• enamel defects

Question 18

What can cause gingival overgrowth?

Answer 18

• hereditary gingival fibromatosis
• cyclosporine
• phenytoin
• nifedipine
• puberty

Question 19

How should patients with gingival overgrowth be managed?

Answer 19

• rigorous home care
• frequent PMPR
• +/- surgery if severe (especially for drug induced pts)

Question 20

When might you consider an urgent referral to a physician after a periodontal screen?

Answer 20

Unexplained:
- gingival enlargment
- inflammation
- bleeding
- mobility
That is INCONSISTENT with the level of OH observed

Question 21

What are the four main distinguishing features of periodontitis?

Answer 21

• apical migration of junctional epithelium beyond CEJ
• loss of attachment of periodontal tissues to cementum
• transformation of junctional epithelium to pocket epithelium (thin and ulcerated)
• alveolar bone loss

Question 22

What is considered an early sign of periodontitis in teenagers?

Answer 22

> 1mm loss of attachment

Question 23

What are the features of periodontitis (molar incisor pattern)?

Answer 23

• rapid attachment loss and bone destruction
• patient is otherwise healthy
• onset around puberty
• family history of disease

Question 24

What systemic diseases may manifest as periodontitis in children?

Answer 24

• papillon-lefevre syndrome (PLS)
• neutropenias
• down syndrome
• ehlers-danlos syndrome

Question 25

At what age in children should you do a BPE?

Answer 25

7-18 years old

Question 26

What probe is used to do a simplified BPE?

Answer 26

WHO 621 probe
- single black band

Question 27

On which teeth is a simplified BPE carried out?

Answer 27

16, 11, 26, 36, 31, 46
(starts at 7y/o)

Question 28

What can be used to assess a patients OH levels?

Answer 28

SDCEP Plaque Scores

Question 29

What are the different plaque scores based on SDCEP guidance?

Answer 29

10/10 = perfectly clean tooth

8/10 = line of plaque around cervical margin

6/10 = cervical 1/3 or crown covered

4/10 = middle 1/3 of crown covered

Question 30

From what age can you perform a full BPE?

Answer 30

12+ onwards usually